{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T01:39:15Z","timestamp":1792460355849,"version":"4.5.0"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":18,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Endoscopic management of symptomatic pancreatic stones (P\u2010Stones) with main pancreatic duct (MPD) strictures due to chronic pancreatitis remains challenging. For refractory P\u2010Stones, high\u2010quality evidence for endoscopic treatment remains limited, and endoscopic ultrasound\u2010guided pancreatogastrostomy (EUS\u2010PGS) is considered a potential salvage option. This single\u2010center retrospective study enrolled 16 consecutive patients with symptomatic refractory P\u2010Stones who underwent EUS\u2010PGS between June 2017 and June 2025, after failed transpapillary access or, in cases of surgically altered anatomy (SAA), with pancreatojejunal anastomotic stricture. Following EUS\u2010PGS, procedures via the endosonographically created route (ESCR) and conversion to transpapillary approaches were used to manage stones and strictures, with multiple plastic stents placed to maintain ESCR patency. Technical success was defined as P\u2010Stones treatment, and clinical success as symptom improvement after complete stone clearance. EUS\u2010PGS achieved 100% technical and 93.8% clinical success. Complete stone removal was achieved in 15 of 16 cases (93.8%), with 1 case still under treatment. Early adverse events (AEs) occurred in 18.8% of cases (pancreatic leakage, mild pancreatitis), and late AEs in 12.5% (bleeding, stent migration). The median stone removal time was 350\u2009days. Procedural times were similar between the normal anatomy and SAA groups, although the puncture\u2010to\u2010stent interval tended to be longer in the normal anatomy group (40 vs. 25\u2009min,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.05). EUS\u2010PGS demonstrated high technical and clinical success for symptomatic P\u2010Stones, with an acceptable AE rate. However, the long treatment period, often related to the absence of dedicated devices, remains a limitation that warrants improvement.\n                  <\/jats:p>","DOI":"10.1111\/den.70314","type":"journal-article","created":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:57:40Z","timestamp":1792457860000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Usefulness of Endoscopic Ultrasound\u2010Guided Pancreatogastrostomy and the Related Trans\u2010Endosonographically Created Route Procedure for the Management of Refractory Pancreatic Stones (With Video)"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6206-9236","authenticated-orcid":false,"given":"Ko","family":"Tomishima","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3308-9326","authenticated-orcid":false,"given":"Hiroyuki","family":"Isayama","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"},{"name":"Division of Gastroenterology, Department of Medicine, Faculty of Medicine Chulalongkorn University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4151-7765","authenticated-orcid":false,"given":"Shigeto","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akinori","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5036-4545","authenticated-orcid":false,"given":"Yusuke","family":"Takasaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4331-7900","authenticated-orcid":false,"given":"Sho","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Arii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takumi","family":"Okuaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Hagiwara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Yamaguchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhisa","family":"Jimbo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9025-0846","authenticated-orcid":false,"given":"Ippei","family":"Ikoma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9404-7827","authenticated-orcid":false,"given":"Daishi","family":"Kabemura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroto","family":"Ota","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muneo","family":"Ikemura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2542-9927","authenticated-orcid":false,"given":"Tomoya","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4455-4845","authenticated-orcid":false,"given":"Taito","family":"Fukuma","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mako","family":"Ushio","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumi","family":"Kurata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7367-0767","authenticated-orcid":false,"given":"Toshio","family":"Fujisawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Juntendo University  Bunkyo\u2010ku Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1067\/mge.2002.125547","article-title":"EUS\u2010Guided Pancreaticogastrostomy","volume":"56","author":"Fran\u00e7ois E.","year":"2002","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1111\/den.12100","article-title":"Endoscopic Ultrasonography\u2010Guided Pancreatic Duct Drainage After Failed Endoscopic Retrograde Cholangiopancreatography in Patients With Malignant and Benign Pancreatic Duct Obstructions","volume":"25","author":"Kurihara T.","year":"2013","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1097\/MPA.0000000000002003","article-title":"Efficacy and Safety of Peroral Pancreatoscopy Through the Fistula Created by Endoscopic Ultrasound\u2010Guided Pancreaticogastrostomy","volume":"51","author":"Suzuki A.","year":"2022","journal-title":"Pancreas"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1055\/a-1717-1391","article-title":"Therapeutic Endoscopic Ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline","volume":"54","author":"Merwe S. W.","year":"2022","journal-title":"Endoscopy"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13102840","article-title":"Dedicated Echoendoscope for Interventional Endoscopic Ultrasound: Comparison With a Conventional Echoendoscope","volume":"13","author":"Fujisawa T.","year":"2024","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/den.14927","article-title":"Proposal of Classification and Terminology of Interventional Endoscopic Ultrasonography\/Endosonography","volume":"37","author":"Isayama H.","year":"2025","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","DOI":"10.1002\/deo2.393","article-title":"Technical Review of Endoscopic Ultrasound\u2010Guided Drainage\/Anastomosis and Trans\u2010Endosonographically Created Route Procedures for the Treatment of Pancreatic Diseases","volume":"5","author":"Tomishima K.","year":"2025","journal-title":"DEN Open"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","DOI":"10.3390\/jcm14041214","article-title":"Development of a Dedicated X\u2010Ray Fluoroscopic Apparatus for Therapeutic Pancreatobiliary Endoscopy: A Review","volume":"14","author":"Fukuma T.","year":"2025","journal-title":"Journal of Clinical Medicine"},{"key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A Lexicon for Endoscopic Adverse Events: Report of an ASGE Workshop","volume":"71","author":"Cotton P. B.","year":"2010","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_10_11_1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.4103\/sjg.sjg_81_21","article-title":"Usefulness of Routine Plain CT the Day After an Interventional EUS Procedure","volume":"27","author":"Kiyanagi A.","year":"2021","journal-title":"Saudi Journal of Gastroenterology"},{"key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1016\/j.gie.2008.12.233","article-title":"Single\u2010Operator EUS\u2010Guided Cholangiopancreatography for Difficult Pancreaticobiliary Access (With Video)","volume":"70","author":"Brauer B. C.","year":"2009","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_10_13_1","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/den.13746","article-title":"Endoscopic Management of Pancreatic Diseases in Patients With Surgically Altered Anatomy: Clinical Outcomes of Combination of Double\u2010Balloon Endoscopy\u2010 and Endoscopic Ultrasound\u2010Guided Interventions","volume":"33","author":"Kogure H.","year":"2021","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_10_14_1","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1007\/s10620-019-05495-9","article-title":"Anterograde Endoscopic Ultrasound\u2010Guided Pancreatic Duct Drainage: A Technical Review","volume":"64","author":"Krafft M. R.","year":"2019","journal-title":"Digestive Diseases and Sciences"},{"key":"e_1_2_10_15_1","doi-asserted-by":"crossref","first-page":"210","DOI":"10.4103\/sjg.SJG_474_18","article-title":"Endoscopic Ultrasound\u2010Guided Pancreatic Duct Drainage","volume":"25","author":"Nakai Y.","year":"2019","journal-title":"Saudi Journal of Gastroenterology"},{"key":"e_1_2_10_16_1","doi-asserted-by":"crossref","first-page":"E1664","DOI":"10.1055\/a-1236-3350","article-title":"Efficacy and Safety of Endoscopic Ultrasound\u2010Guided Pancreatic Duct Drainage (EUS\u2010PDD): A Systematic Review and Meta\u2010Analysis of 714 Patients","volume":"8","author":"Chandan S.","year":"2020","journal-title":"Endoscopy International Open"},{"key":"e_1_2_10_17_1","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1111\/den.14998","article-title":"Complete Clearance of Painless Pancreatic Stones With Endotherapy Prevents the Progression of Pancreatic Parenchyma Atrophy in Patients With Chronic Pancreatitis: Multicenter Cohort Study","volume":"37","author":"Ikeura T.","year":"2025","journal-title":"Digestive Endoscopy"},{"key":"e_1_2_10_18_1","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.gie.2016.07.030","article-title":"EUS\u2010Guided Pancreatic Drainage for Pancreatic Strictures After Failed ERCP: A Multicenter International Collaborative Study","volume":"85","author":"Tyberg A.","year":"2017","journal-title":"Gastrointestinal Endoscopy"},{"key":"e_1_2_10_19_1","doi-asserted-by":"crossref","first-page":"E136","DOI":"10.1055\/a-2239-4737","article-title":"Successful Retrieval of a Migrated Stent in the Pancreatic Duct After Endoscopic Ultrasound\u2010Guided Pancreaticogastrostomy With Peroral Pancreatoscopy","volume":"56","author":"Takahashi S.","year":"2024","journal-title":"Endoscopy"},{"key":"e_1_2_10_20_1","first-page":"1","article-title":"Current Paradigm of Endoscopic Ultrasound in Biliary and Pancreatic Duct Drainage: An Update","volume":"37","author":"Jearth V.","year":"2024","journal-title":"Annals of Gastroenterology"},{"key":"e_1_2_10_21_1","doi-asserted-by":"crossref","first-page":"E135","DOI":"10.1055\/a-2187-7263","article-title":"EUS\u2010Guided Laser Lithotripsy for Pancreatic Duct Stones After Failed Conventional Pancreatic Endotherapy","volume":"12","author":"Emmanuel J.","year":"2024","journal-title":"Endoscopy International Open"}],"container-title":["Digestive Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/den.70314","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/den.70314","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/den.70314","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:57:43Z","timestamp":1792457863000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/den.70314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":20,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/den.70314"],"URL":"https:\/\/doi.org\/10.1111\/den.70314","archive":["Portico"],"relation":{},"ISSN":["0915-5635","1443-1661"],"issn-type":[{"value":"0915-5635","type":"print"},{"value":"1443-1661","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-01-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70314"}}